NEW: On April 10, 2015, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule outlining how the federal parity law would be applied to Medicaid, to the Medicaid expansion population through alternative benefit plans, and to the Children’s Health Insurance Program (CHIP). Comments are due June 9, 2015.

On December 6, 2013, NAPHS participated in a summit on “Achieving Parity: Moving Forward after the Final Rule” hosted by former Rep. Patrick Kennedy (left photo) with a group of 25 key national health and mental health organizations to focus on how collective efforts can help ensure effective implementation of mental health parity. NAPHS President/CEO Mark Covall (2nd photo, right) joined Neil Kirschner of the American College of Physicians on a panel discussion.

VICTORY! Federal law (the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008) now addresses longstanding discrimination against those who rely on their health plans for coverage of mental and addictive disorders. And a final rule was issued November 8, 2013. The law:

extends equal coverage to an estimated 113 million Americans who work for employers with 51 employees or more

for the first time, this includes workers in companies that are self-insured

establishes visit and day limits that cannot be more restrictive than those for medical/surgical services

establishes copays and deductibles that cannot be more restrictive than those for medical/surgical services

requires that if a health plan offers out-of-network coverage, it must also include out-of-network parity for mental health

establishes a floor, but state parity laws can go beyond the federal law

allows management of the benefit

becomes effective one year after enactment (effective October 2009)

Mental health parity has won unprecedented support from consumers, providers, hospitals, employers, and health insurers. With millions of Americans experiencing psychiatric and addictive conditions, having coverage that is on par with that of other medical conditions is a win for America.

Mental health parity:

Saves lives. Mental illnesses constitute the second leading cause of disability and premature death in the United States. As the President’s New Freedom Commission on Mental Health noted, however, about one out of every two people who needs mental health treatment in this country does not receive it.

Is cost-effective. Providing parity for mental illnesses is affordable. Research and actual industry experiences indicate that parity can be implemented without substantially increasing premiums. Studies have concluded that parity would increase premiums less than 2%.

Is fair. Mental health parity is the right thing to do. Mental health parity is a win for America!

NAPHS was a founding member of the Coalition for Fairness in Mental Illness Coverage, which helped to win passage of this landmark legislation.

NAPHS is working with Congress and federal agencies to implement and clarify the federal parity regulations. The association is also working to end remaining vestiges of discrimination, including eliminating the Medicare 190-day lifetime limit.

Web-based ParityTrack is a central site for mental health and substance use disorder parity information produced by the Kennedy Forum, Scattergood Foundation, and Treatment Research Institute. Reports analyze legislation, regulatory actions, and litigation at the federal and state levels.

5/6/2015

Group letter to Labor, IRS, and HHS requesting additional guidance related to the full implementation and enforcement of the federal parity law

4/15/2015

Parity Implementation Coalition release: "Release of Medicaid Parity Proposed Rule Lauded as Important Step for Those with Addiction and Mental Illness"

Coalition for Whole Health (CWH): Toolkit for state-level advocates working on implementation and oversight of the Affordable Care Act’s (ACA’s) essential health benefits, parity, and network adequacy protections. See an overview of key issues and short guides for working with state legislatures and insurance commissioners.

Employee Benefits Security Administration (EBSA) guidance on the classification of outpatient benefits (federal agencies will not take enforcement action against any plan or insurer that distinguishes between office visits and all other outpatient services while they complete final regulations on the law) [View]